CVD Flashcards
Endocarditis Sx
Fever, New Murmur, Janeway lesions (nontender on palms/soles), Osler’s nodes (tender nodules of finger/toe pads), Roth spots (red retinal lesions w. pale centers
Endocarditis Dx
Modified Duke Criteria
TEE
positive blood cultures
Endocarditis Tx
Empiric tx = vancomycin + ceftriaxone Prosthetic valve = add rifampin & gentamicin
Arrhythmias
An abnormality in the timing or pattern of the heartbeat caused by a variety of things
Brady or tachy
Cardiac Tamponade Sx
Becks triad: hypotension, JVD, muffled heart sounds
Becks triad
Hypotension, JVD, muffled heart sounds
Cardiac tamponade Dx
EKG: Sinus tachy, low voltage, electrical alternans
POCUS triad (US): Pericardial fluid, RV diastolic collapse, Dilated IVC
Cardiac Tamponade Tx
Pericadiocentesis
Chest Pain
Nonspecific, can be caused by a variety of disorders like MI’s, anginas, pneumonia, PE
AFib Dx
EKG: No identifiable P waves, varying R-R intervals
AFib Sx
Unexplained fatigue, palpitations, fainting, SOB, chest pain, stroke (common from left atrial appendage)
AFib Tx and management
Anticoagulation: rivaroxaban, apixaban, dabigatran, edoxaban, warfarin, heparin
Rate control – older, preserved EF, asymptomatic. Rx = BB, CCB
Rhythm control – younger, symptomatic, EF <45%, new onset
Cardioversion or ablation if the above doesnt work
CHA2DS2-VASc
Anticoagulation if score is 2+.
1 pt: CHF, HTN, DM, Vascular disease (MI, PAD, atherosclerosis), age 65-74, female
2 pt: age 75+, stroke/TIA
Atrial Flutter dx
EKG: Produces a classic “sawtooth” pattern of atrial activity with lack of P waves
Atrial Flutter Tx
Anticoagulation
Cardioversion, if hemodynamically unstable
SVT definition
Rapid rhythm disturbances originating from the atria or the atrioventricular node (narrow complex)
SVT Sx
Abrupt onset, heart racing/palpitations, SOB, diaphoresis, chest pain, rapid breathing, dizziness, loss of consciousness
SVT dx
EKG: narrow QRS complex, usually 160-220 bpm, rate does not vary
SVT Tx
Physical maneuver if isolated incidences (valvsalva, hold breath, head btw knees, ice water)
IV Adenosine (in acute setting) Only give adenosine if narrow QRS
Send for EP study (stable), cardiovert (if unstable)
Ablation (definitive treatment)
LBBB vs RBBB
LBBB= wide QRS (>0.12s), will have –> think batman
RBBB = left ventricle depolarizes first, then right (b/c that’s where delay is) –> think rabbit ears
V1, V2 = RBBB
V5, V6 = LBBB
VTach EKG findings and Sx
EKG: Wide QRS (>120ms) originating from ventricles (rate >100)
Sx: May present as syncope +/- hemodynamic stability
VTach Tx (initial vs long term)
Initial: Urgent cardioversion, IV amiodarone
Long-term: reverse cause, BB if structural heart disease, ablation, ICD if cardiomyopathy/EF<35% after GDMT
Torsades de pointes causes, EKG findings, and Tx
Cause: commonly hypomagnesemia if electrolyte disturbance
Clinical Pearl: Prolonged QT interval = higher risk of developing polymorphic VT
Tx: IV magnesium
VFib EKG findings and tx
What happens to ventricles during VFib?
Main cause of sudden cardiac death in pts w. MI
Ventricles quivering w. no forward cardiac output
EKG: Chicken scratch
Tx: ACLS (defibrillation, epinephrine, antiarrhythmics)